From the FDA Drug Label
The effectiveness of sertraline for the treatment of PMDD was established in two double-blind, parallel group, placebo-controlled flexible dose trials (Studies 1 and 2) conducted over 3 menstrual cycles Sertraline treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment While a relationship between dose and effect has not been established for PMDD, patients were dosed in the range of 50 to 150 mg/day with dose increases at the onset of each new menstrual cycle
The treatment guidelines for Premenstrual Dysphoric Disorder (PMDD) include:
- Initiating sertraline treatment with a dose of 50 mg/day
- Administering the dose either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment
- Dosing patients in the range of 50 to 150 mg/day with dose increases at the onset of each new menstrual cycle
- Considering dose increases up to 150 mg/day when dosing daily throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle 1
- The dosage and administration for PMDD is further supported by 1 which states that sertraline treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle.
From the Research
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for premenstrual dysphoric disorder (PMDD), and they can be taken continuously or only during the luteal phase. The treatment of PMDD typically involves a combination of lifestyle modifications, psychotherapy, and medication. Some key points to consider when treating PMDD include:
- First-line pharmacological treatment is SSRIs such as fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily) 2.
- SSRIs are effective because PMDD involves dysregulation of serotonin systems.
- For women who don't respond to SSRIs, hormonal treatments may be considered, including combined oral contraceptives containing drospirenone (such as Yaz), which is FDA-approved for PMDD.
- Non-pharmacological approaches include cognitive behavioral therapy, regular exercise, stress management techniques, and dietary changes (reducing caffeine, salt, and alcohol).
- Calcium (1200mg daily) and vitamin B6 (50-100mg daily) supplements may provide modest benefits.
- Treatment should be individualized, with regular follow-up to assess effectiveness and adjust as needed.
- Symptoms typically improve within 1-2 menstrual cycles after starting treatment 2. It's worth noting that the most recent and highest quality study, published in 2024, found that SSRIs probably reduce premenstrual symptoms in women with PMS and PMDD and are probably more effective when taken continuously compared to luteal phase administration 2.